Skip to content Skip to navigation
University of Warwick
  • Study
  • |
  • Research
  • |
  • Business
  • |
  • Alumni
  • |
  • News
  • |
  • About

University of Warwick
Publications service & WRAP

Highlight your research

  • WRAP
    • Home
    • Search WRAP
    • Browse by Warwick Author
    • Browse WRAP by Year
    • Browse WRAP by Subject
    • Browse WRAP by Department
    • Browse WRAP by Funder
    • Browse Theses by Department
  • Publications Service
    • Home
    • Search Publications Service
    • Browse by Warwick Author
    • Browse Publications service by Year
    • Browse Publications service by Subject
    • Browse Publications service by Department
    • Browse Publications service by Funder
  • Help & Advice
University of Warwick

The Library

  • Login
  • Admin

Beyond adoption : a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies

Tools
- Tools
+ Tools

Greenhalgh, Trisha, Wherton, Joseph, Papoutsi, Chrysanthi, Lynch, Jennifer, Hughes, Gemma, A'Court, Christine, Hinder, Susan, Fahy, Nick, Procter, Rob and Shaw, Sara (2017) Beyond adoption : a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. Journal of Medical Internet Research, 19 (11). e367. doi:10.2196/jmir.8775

[img]
Preview
PDF
WRAP-beyond-adoption-framework-evaluating-scale-up-Procter-2017.pdf - Published Version - Requires a PDF viewer.
Available under License Creative Commons Attribution 4.0.

Download (2045Kb) | Preview
Official URL: http://doi.org/10.2196/jmir.8775

Request Changes to record.

Abstract

Background

Many promising technological innovations in health and social care are characterized by nonadoption or abandonment by individuals or by failed attempts to scale up locally, spread distantly, or sustain the innovation long term at the organization or system level.

Objective

Our objective was to produce an evidence-based, theory-informed, and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program.

Methods

The study had 2 parallel components: (1) secondary research (hermeneutic systematic review) to identify key domains, and (2) empirical case studies of technology implementation to explore, test, and refine these domains. We studied 6 technology-supported programs—video outpatient consultations, global positioning system tracking for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organizing software, and integrated case management via data sharing—using longitudinal ethnography and action research for up to 3 years across more than 20 organizations. Data were collected at micro level (individual technology users), meso level (organizational processes and systems), and macro level (national policy and wider context). Analysis and synthesis was aided by sociotechnically informed theories of individual, organizational, and system change. The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback.

Results

The literature review identified 28 previous technology implementation frameworks, of which 14 had taken a dynamic systems approach (including 2 integrative reviews of previous work). Our empirical dataset consisted of over 400 hours of ethnographic observation, 165 semistructured interviews, and 200 documents. The final nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework included questions in 7 domains: the condition or illness, the technology, the value proposition, the adopter system (comprising professional staff, patient, and lay caregivers), the organization(s), the wider (institutional and societal) context, and the interaction and mutual adaptation between all these domains over time. Our empirical case studies raised a variety of challenges across all 7 domains, each classified as simple (straightforward, predictable, few components), complicated (multiple interacting components or issues), or complex (dynamic, unpredictable, not easily disaggregated into constituent components). Programs characterized by complicatedness proved difficult but not impossible to implement. Those characterized by complexity in multiple NASSS domains rarely, if ever, became mainstreamed. The framework showed promise when applied (both prospectively and retrospectively) to other programs.

Item Type: Journal Article
Subjects: R Medicine > R Medicine (General)
T Technology > T Technology (General)
Divisions: Faculty of Science > Computer Science
Library of Congress Subject Headings (LCSH): Medical care -- Technological innovations, Diffusion of innovations, Organizational change, Medical records -- Data processing, Medical innovations, Hospitals -- Outpatient services, Mild cognitive impairment, Monitor alarms (Medicine), Biochemical markers
Journal or Publication Title: Journal of Medical Internet Research
Publisher: Journal of Medical Internet Research
ISSN: 1438-8871
Official Date: November 2017
Dates:
DateEvent
November 2017Available
23 September 2017Accepted
Volume: 19
Number: 11
Article Number: e367
DOI: 10.2196/jmir.8775
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
Health Services and Delivery Research Grant: 13/59/26[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
RP-DG-1213-10003[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
NIHR-BRC-1215-20008[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
WT104830MAWellcome Trusthttp://dx.doi.org/10.13039/100004440
Open Access Version:
  • Publisher

Request changes or add full text files to a record

Repository staff actions (login required)

View Item View Item

Downloads

Downloads per month over past year

View more statistics

twitter

Email us: wrap@warwick.ac.uk
Contact Details
About Us